Pregnancy Prevention Flashcards
Treatment Options
OCs
Vaginal Rings
Transdermal patches
Etonogestrel implant
IUDs
Injection
Non-pharm options: condoms, vasectomy/ligation, spermicides, abstinence
CoCs
IND: Contraception, acne
MOA: Inhibit ovulation via suppression of FSH/LH. Contain estrogen and progestin
BOX: Cigarette smoking increases risk of CV dz especially after 35 and high quantity of cigarettes
CON: Breast cancer, Hepatic dz, pregnancy, thromboembolic disorders, UnDx bleeding, use with Hep C drugs (ritonavir/ombitasvir), uncontrolled HTN, HA w/aura, heart dz’s, pts over 35 who smoke
ADR:
Treatment Pearls of CoCs
May be started within 5 days after the start of the menstrual bleeding (Quick start, all good for contraception).
If greater than 5 days, additional contraception required for 7 days. (Sunday start)
No menstrual cycles: Start whenever
Breastfeeding: Under 6 wks, none. 6wks-6 months, non-preferred. Past 6 months, all good
Non-breast feeding: don’t use until 21 days postpartum
Abortioned: May take immediately
V/D: within 24 hrs, take an additional active
CoC Therapy
Lower doses = lower risk/efficiency. Start in 20-35mcg range. Can be increased if bleeding occurs.
50mcg: Uncontrolled HMB or drug interactions that require higher doses
24/4 are preferred over 21/7 b/c withdrawal side effects from bigger gap
Monophasic preferred over multiphasic
Missing a single dose, take another asap or 2 pills the next day
Don’t interfere with ABX
Progestin only oral contraceptives
“Mini pills”
For women who can’t have estrogen
Efficacy is greater in implant, injection, and IUD. PoP efficacy is lower than CoC’s b/c of timing; cannot miss days
Norethindrone
IND: Contraception, AUB
MOA: Progestin. 0.35mg: Contraception. 5mg: Bleeding
BOX: n/a
CON: Thromboembolic disorders, undx bleeding, breast cancer, pregnancy, hepatic impairment
ADR: Amenorrhea, hot flashes, weights
Drospirenone
IND: Contraception
MOA: Endogenous progestin
Box: n/a
CON: renal impairment, adrenal insufficiency, cervical cancer/progestin-sensitive cancers, liver tumors, hepatic impairment, UnDx bleeding
ADR: n/a
24 hour missed pill window = claim to fame
Etonogestrel
IND: Contraception
MOA: Progestin implant
BOX: n/a
CON: Progestin-sensitive cancers, hepatic tumors/dz, pregnancy, thromboembolic disorders, AUB
ADR: Amenorrhea, weight gain
Levonorgestrel IUD
Mirena and Liletta
IND: HMB, Contraception
MOA: Endogenous progestin
BOX: n/a
CON: Pregnancy, post-coital contraception, breast cancers and other hormone cancers, inflammation like PID, cervicitis, vaginitis, hepatic impairment/dz, uterine anomalies
ADR: Amenorrhea, Ovarian cysts, BV, Vaginal Mycosis
Medroxyprogesterone Acetate
only the shot (depo provera) works as contraception
IND: Contraception, AUB
MOA: Progestin
BOX: Not for long term contraception (under 2 years).
Loss of Bone marrow
CON: Active Thrombophlebitis, Cerebral vascular dz, Thromboembolic disorders, undx bleeding, breast cancer, pregnancy, hepatic impairment
ADR: Amenorrhea, weights, hot flashes
Unscheduled Bleeding
Ensure it isn’t another etiology (including pregnancy), more common with progestin only methods
Increasing Estrogen is a good first step, up to 25-35mcg
Ethynodiol Diacetate and Norethindrone
1st Gen
Lower risk of thrombosis than other progestins.
Mildly androgenic
Levonorgestrel and Norgestrel
Greater risk of thrombosis than first gens
More andronergic than first gens
Prolonged 1/2 life
Desogestrel and Norgestimate
3rd gen
Greater risk of thrombosis than 1st gens, especially desogestrel
Less andronergic than 1st gens
Dienogest and Drospirenone
Greater risk of thrombosis than with other progestins, especially Drospirenone.
Less andronergic than 1st gens
Low risk of acne and hirsutism
Drospirenone only: Risk of hyperkalemia
